Health plans must submit audited HEDIS data to achieve NCQA Accreditation and/or meet employer expectations. HEDIS Compliance Audit Standards, Policies and Procedures describes in detail the methodology used for auditing a health plan's data collection programs, calculation processes and HEDIS measure results. This Volume also includes the standards and guidelines for assessing a health plan's information systems capabilities, and the standards and guidelines used to evaluate a plan's ability to comply with HEDIS specifications.
HEDIS (The Healthcare Effectiveness Data and Information Set) is the gold standard in health care performance measurement, used by more than 90 percent of the nation's health plans and many leading employers and regulators. HEDIS is a set of standardized measures that specifies how organizations collect, audit and report performance information across the most pressing clinical areas, as well as important dimensions of customer satisfaction and patient experience.